Prevent Cervical Cancer with the Right Test at the Right Time

Screening tests can find abnormal cells so they can be treated before they turn into cancer.

The Pap test looks for changes in cells on the cervix that could turn into cancer if left untreated.

The human papillomavirus (HPV) test looks for the virus that causes these cell changes.

The only cancer the Pap test screens for is cervical.

HPV is the main cause of cervical cancer. HPV is a very common virus, passed from one person to another during sex. Most people get it, but it usually goes away on its own. If HPV doesn’t go away, it can cause cancer.

Most women don’t need a Pap test every year!

Have your first Pap test when you’re 21. If your test results are normal, you can wait 3 years for your next Pap test. HPV tests aren’t recommended for screening women under 30.

When you turn 30, you have a choice:

If your test results are normal, get a Pap test every 3 years. OR

Get both a Pap test and an HPV test every 5 years.

You can stop getting screened if:

You’re older than 65 and have had normal Pap test results for many years.

Your cervix was removed during surgery for a non-cancerous condition like fibroids.

The cervix is the lower, narrow end of the uterus (womb) that connects the uterus to the vagina (birth canal). A diagram of the female reproductive system shows the ovaries, Fallopian tubes, cervix, uterus, vagina, and vulva.

1. The most common symptom of sexually transmitted infections (STIs) is feeling fine and having zero signs of a disease.

Reason #482 to get tested: Most infections come with no symptoms at all. So unless your genitals are psychic, you need regular screenings whenever you’re at risk. And just because an STI isn’t causing symptoms, that doesn’t mean it’s harmless. Untreated chlamydia and gonorrhea in cisgender women or trans men can lead to chronic pelvic pain, ectopic pregnancy, and even infertility.

2. HALF of all new STIs happen to people under the age of 25.

That’s huge considering this group makes up just a quarter of the sexually active population, according to a 2013 report from the CDC.

3. You should START getting tested after your first sexual encounter — whenever and whatever that may be.

STIs can be spread through oral, anal, and vaginal sex — and sometimes just through skin-to-skin genital contact (which is the case with HPV and herpes) or sharing sex toys. So if you’re engaging in any activities that can result in transmission — even if you think your partner is STI-free — it’s time to talk to your doctor about which tests you should be getting.

4. If you’ve been exposed to an STI, it might take a little while for it to show up on a test.

Different STIs can take a matter of days or weeks to show up on a test, Dr. Peter Leone, medical director at the North Carolina HIV/STD Prevention and Control Branch, tells BuzzFeed Life. So keep that in mind when you’re getting tested (and when you’re scheduling an appointment). Plus, it can take up to 3 months to detect HIV depending on which test you get (more on that later).

5. You can get an STI test without your parents’ consent.

Minors are allowed to consent for their own health services for STIs, anywhere in the U.S., according to the CDC. That said, they cannot stop your private insurance company from sending an explanation of benefits or a medical bill to your parents if they are the primary insurance holders (and those forms typically list the tests you had). Still, talk to your doctor if you think you may be at risk for an STI and they should be able to help you make the best decision.

6. Your insurance should cover some or all of the costs for STI testing. But if they don’t, there are always cheap or free options out there.

Any screening recommendation from the U.S. Preventative Services Task Force that’s graded A or B must be covered by insurance (if you’re in the U.S.). These recommendations are pretty consistent with the ones from the CDC, which we’ll go over in detail here.

Your insurance might only cover annual screenings for certain STIs. But if you have symptoms or you’re at a higher risk, that would be considered an STI “test” rather than a “screening,” and if it’s coded correctly, your insurance should still cover it, says Leone. You can also find free or cheap testing at local health departments, health clinics, or Planned Parenthood, he says. You can also go to GetTested.cdc.gov to find affordable testing centers in your area.

7. Ideally, you want to get tested in between partners.

This way you’re able to approach a new partner with a clean slate. And if you do have an infection, you’re able to pinpoint when you got it and find out how to not pass it along to your next partner. If you have multiple partners or you’re switching partners more frequently than you can be tested, make sure to practice safer sex practices by using a barrier method every single time. And don’t assume that if you slipped up once with someone, the damage is already done and it’s not worth using a condom the next time.

First, here are the most basic screening guidelines for cisgender men and women. Suggestions for trans individuals come next.

These recommendations for cisgender men and women (which means they identify with the gender they were assigned at birth), come from the 2010 CDC STD Treatment Guidelines. Keep in mind that your lifestyle, community, and unique sexual behaviors may mean that you should be screened more or less frequently. We’ll go into more detail about all that in a bit.

8. If you’re a woman under 25 and you have sex with men or women, you should get a chlamydia test and gonorrhea test every year.

Yes, that’s even if you haven’t switched partners. Why? Because the vast majority of chlamydia infections occur in women under 25 and it’s often completely symptomless, so it’s best to just cover your bases, says Leone. Also, most men aren’t getting screened for chlamydia, so if you have a male partner (even if you’re sure you’re both monogamous), it’s still wise to be tested every year. And remember that sex isn’t just penis-in-vagina. This also includes oral sex, anal sex, the sharing of sex toys, etc.

9. If you’re a woman 25 or older AND you have either a new partner or multiple partners (of either gender), you should also get a chlamydia test and gonorrhea test every year.

So if you’ve hooked up with anyone new since your last test, this is your cue to get retested.

10. If you’re a man who has sex with men (MSM), you should be tested for chlamydia, gonorrhea, and syphilis at least once a year. If you have multiple partners or anonymous partners, you should be screened more often (at 3-month or 6-month intervals).

This includes testing for gonorrhea and chlamydia in the urethra for anyone who has insertive intercourse and in the rectum for anyone who has receptive anal intercourse, as well as testing for gonorrhea in the pharynx (in your mouth where your nose connects to your throat) for anyone who has receptive oral intercourse.

If you have multiple sex partners, or if your partner has multiple sex partners, it is recommended that you screen for these STIs more frequently. This might mean at 3-6 month intervals, so check with a doctor or health clinic to get a specific recommendation.

11. All men who have sex with men should get a baseline screening for hepatitis B if they are unvaccinated or if they aren’t sure if they’ve been vaccinated.

This is a blood test that will determine if you’re infected. In addition to screening, adults should receive hepatitis A and hepatitis B vaccines if they haven’t already. Hepatitis C screening is also recommended in HIV-positive MSM.

12. There are technically no STI screening guidelines for men who only have sex with women (aside from HIV screening) — but that doesn’t necessarily mean you should never get tested.

You should be tested any time one of your sexual partners has been diagnosed with an STI, Dr. Vanessa Cullins, vice president for external medical affairs at Planned Parenthood Federation of America (PPFA), tells BuzzFeed Life. For instance, if your partner has trichomoniasis (a common STI caused by a parasite that’s often asymptomatic in men), you’ll want to get tested ASAP to make sure you don’t reinfect her. Remember, just because you don’t have symptoms, that doesn’t mean the infection is harmless.

In some states, physicians are allowed to give a prescription or medication to a patient to give to their partner if they’ve been diagnosed with chlamydia or gonorrhea — even without examining the partner. This is called expedited partner therapy and you can find out what’s allowed in your state by checking out this map from the CDC.

13. There are also no specific guidelines for women who only have sex with women (WSW).

While there are no recommendations for more frequent STI screenings for WSW (as there are for MSM), there is also no evidence to suggest that WSW should screen less frequently (per the 2014 CDC STD Treatment Guidelines, which are still under consideration). So if a doctor says you don’t need to be screened for something based on your sexual orientation — even though you have certain risk factors or symptoms — don’t be afraid to speak up or find another provider.

14. EVERYONE should get an HIV test at least once.

The CDC recommends that everyone between the ages of 13 and 64 be tested at least once in their life. We’ll talk more about the different kinds of HIV tests in a little bit. For more information, check out the CDC guide to HIV testing.

15. But that doesn’t necessarily mean you ONLY need one HIV test in your whole lifetime.

If you change partners or have unprotected sex, you should probably be tested annually, suggests Leone. You should also be tested more frequently if you’re in a high-risk group, which could include any of the following: You’ve had sex with someone who might be HIV-positive, you’ve had sex with someone and you don’t know their HIV status, you have multiple partners, you’ve had sex with someone who might have multiple partners, you’re a man who has sex with men, you have a history of drug injection, you’re a commercial sex worker, you live in a community where HIV is particularly prevalent, etc.

There are no hard and fast recommendations for how often most of these groups should be tested for HIV, so it’s important to talk about your risk with a doctor and determine the best screening guidelines for you. For the most part, you should be tested (or at least ask your doctor about your risk) annuallyunless you’re in a mutually monogamous relationship and you’ve both been tested.

16. If you’re a man who has sex with men, you should get an HIV test every year. If you have multiple partners or anonymous partners, you should be screened more often (at 3-6 month intervals).

17. Pregnant women should be tested for syphilis, HIV, chlamydia, and hepatitis B (and retested if necessary). They should also be screened for gonorrhea and hepatitis C if they are at risk.

You’re “at risk” for gonorrhea if you are under 25, if you’re over 25 but have new or multiple partners, if you live in a community where gonorrhea is common, if you’ve had gonorrhea before, if you’ve had other STIs, if you don’t use condoms consistently, if you’re a commercial sex worker, or if you use drugs. You’re “at risk” for hepatitis C if you have a history of drug-injection use or a history of blood transfusion or organ transplant before 1992.

Here’s what you need to know about testing for STIs if you’re a transgender man or woman, or if your partner is a transgender man or woman.

Transgender individuals have a gender that is different from what they were assigned at birth. Because gender identity is different than sexual orientation, it’s important to note that trans men and trans women may have sex with any gender. It’s also important to remember that some trans people have had gender confirmation surgery while others have not. All of these factors can influence which STI tests you should be getting and how frequently you should be getting them.

18. Unfortunately, the CDC does not have concrete screening guidelines for trans people.

However, it’s possible to assess your risk by considering your genital anatomy, your partner’s genital anatomy, your sexual behaviors, and other outside risk factors. “It should come down to organs and risk,” Dr. Madeline Deutsch, clinical director at the Center of Excellence for Transgender Health. “Providers should be talking about who you are having sex with, what’s going where, and what are the circumstances that surround that sexual behavior.”

For instance, a trans man with a vagina should get regular Pap tests and STI screenings consistent with the guidelines for cisgender women who have sex with men or women. “A vagina should be screened regardless of who it’s attached to,” says Deutsch. And if you’re having receptive anal sex or have multiple partners with a penis, follow MSM guidelines, regardless of your own gender or sexual identity, or your partners’.

After gender confirmation surgery, the recommendations may be even more personalized. If you have had vaginoplasty, for instance, you may be at a reduced risk for certain infections since there’s no vaginal mucosa and it doesn’t open to the abdominal cavity, explains Deutsch. However, if you have had phalloplasty, it’s not yet known if you would be at an increased or decreased risk of any particular infections, so talk to a doctor about your personal risk factors.

19. Because STI screening for trans people will be based on your unique sexual behaviors and anatomy, it’s important to assess your risk with a healthcare provider to determine which tests you need.

It can be incredibly difficult and intimidating to disclose your gender identity, sexual orientation, and specific sexual behaviors to a doctor, which is why it’s crucial to find a provider who is well versed in this. You can search for LGBT-friendly providers at GLMA.org, WPATH.org, or trans-health.com. These are databases where providers have specifically submitted their offices as being LGBT-friendly or specializing in LGBT care. (Editor’s note: Have other resources you trust? Please post them in comments.)

20. You’ll typically only be tested for herpes if you have symptoms or if you suspect you’ve been exposed. But feel free to ask for the test if you think you’re at risk.

Approximately 1 in 6 adults in the U.S. have genital herpes, and most people don’t know they have it, according to the CDC. Still, routine screening for herpes isn’t recommended (based on cost-effectiveness and the likelihood for false positives in low-risk populations). If you have any symptoms (lesions on or around the mouth, genitals, or rectum that break and leave painful ulcers, which may take weeks to heal), if you’ve been with someone who was diagnosed with herpes, or if you’ve had unsafe sex or sex with multiple partners, ask your doctor if you can be tested.

21. Before you even think about HPV testing, consider getting the HPV vaccine.

HPV (or human papillomavirus) is the most common STI out there, and almost all sexually active people get it at some point in their lives, according to the CDC. Most HPV infections clear on their own, but a few high-risk strains can lead to genital warts or even cancer. The surest defense against HPV is getting vaccinated at an early age. The CDC Advisory Committee on Immunization Practices recommends routine vaccination of all females and males at ages 11 or 12 (but they can get them as early as age 9). They also recommend that women catch up on the vaccine by age 26 and men catch up by age 21 if they haven’t already gotten all three shots. However, men can also be vaccinated up to age 26.

Even if you’ve missed the boat, some experts still suggest getting the vaccine as an adult if you’re at risk. So talk to a doctor about it if you think you would benefit. Just remember that insurance won’t cover the cost after a certain age.

22. If you have a vagina, you should get an HPV test at age 30. But you may get one earlier if you have an abnormal Pap test.

Starting at age 21, all women should be getting a Pap test every 3 years, which looks for cervical cell changes that could point to cancer, per the American College of Obstetricians and Gynecologists. If you’re a trans man with a vagina, you should be following these guidelines, too. If you’re a trans woman and you’ve had bottom surgery, talk to your doctor for specific screening guidelines based on your anatomy.

If your doctor notices anything abnormal in your Pap test, they may call for additional testing — like an HPV test or colposcopy (where they closely examine your uterus and often collect a sample for testing). Otherwise, you wouldn’t have an HPV test until the age of 30, when it’s recommended that you get a Pap test and HPV test together. From ages 30-65, it’s recommended that you get these two tests together every 5 years OR just a Pap test alone every 3 years. However, if you ever have any abnormal Pap test or HPV test, you’ll need to be screened more frequently (at least for a period of time).

23. There is currently no HPV test for anyone with a penis, but there are a few precautions you can take.

Obviously, get vaccinated if you haven’t already. But what should you do if you think you’ve been exposed? Your doctor can do a visual exam for genital warts caused by HPV, since most people actually miss these on their own, says Leone. He also suggests a digital rectal exam and sometimes a rectal pap for men over 30 who may be at risk for HPV. These can check for infections, lesions, or masses in the anal canal, and they would be especially beneficial for those who have receptive anal intercourse.

24. And if you’re ever experiencing ANY strange symptoms, head to your doctor or a health clinic immediately to get tested.

If you notice any itching, burning, unusual discharge, redness, rash, lesions/sores, uncomfortable urination, unusual odor, pain in the penis/testicles/vagina/vulva/pelvic region/lower abdomen, or anything else that seems really off, get it checked out. There are some STIs that you might only get tested for if you have certain symptoms (like trichomoniasis, bacterial vaginosis, and sometimes syphilis), so don’t assume that you’ll just deal with it at your next annual check-up.

25. Chlamydia and gonorrhea are typically urine tests or swab tests.

The doctor might take a cell sample from the cervix, penis, vagina, or anus or test any discharge (per Planned Parenthood). If you’ve had oral sex or anal sex, they may also collect swabs from your throat or rectum.

27. Testing for trichomoniasis and bacterial vaginosis are both done by testing discharge from the vagina or the urethra (in the case of trichomoniasis).

28. HPV testing is a swab test that examines cell samples from the cervix.

29. Genital warts are diagnosed through a physical exam or colposcopy.

30. There are a few different ways to test for herpes.

If you currently have symptoms or lesions, your doctor can take a swab of the area, which is called a direct test. If a swab test is negative, your doctor may take a blood test to confirm. Most providers recommend type-specific serologic tests, whichare blood tests that can detect the antibodies for either herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2).

31. There are few different ways to test for HIV.

The most common HIV test is the antibody screening test (also called immunoassay), which detects the antibodies your body makes against HIV (per the CDC). This can be either a blood test or an oral swab. Either of those can be run as either a lab test or a rapid test, which gives results in 30 minutes or less. But keep in mind: Lab-based blood tests typically pick up the virus before the oral tests and the rapid tests do. If the test is negative and you may have been exposed in the past 3 months, you should get another test after 3 months, since it’s possible that your immune system hasn’t made the antibodies yet or that the test wasn’t able to pick them up yet.

A newer type of HIV test looks for both antibodies and the antigen (which is part of the virus itself). This one is a blood test and it may be able to detect the virus as soon as 3 weeks after exposure.

Regardless of which test you use, any positive result would need to be confirmed by a follow-up lab test. There are several different kinds of these as well, and you can find out more about them here.

32. Talking about STI testing with your partner is normal and necessary.

Even though it seems like it, this is not an exhaustive list of everything there is to know about STIs and testing. There are so many unique cases and exceptions to the rules, which is why this should be an ongoing conversation — not a pamphlet to glance at every once in a while. Talk with your partner about what you’re doing now, what you’ve done in the past, and what you’ve been tested for recently. Then have this conversation with your doctor to make sure you’re getting the right tests at the right frequency.

Herpes is a common sexually transmitted disease (STD) that any sexually active person can get. Most people with the virus donâ€™t have symptoms. It is important to know that even without signs of the disease, it can still spread to sexual partners.

Basic Fact Sheet |What is genital herpes?

Genital herpes is an STD caused by two types of viruses. The viruses are called herpes simplex type 1 and herpes simplex type 2.

How common is genital herpes?

Genital herpes is common in the United States. In the United States, about one out of every six people aged 14 to 49 years have genital herpes.

How is genital herpes spread?

You can get herpes by having vaginal, anal, or oral sex with someone who has the disease.

Fluids found in a herpes sore carry the virus, and contact with those fluids can cause infection. You can also get herpes from an infected sex partner who does not have a visible sore or who may not know he or she is infected because the virus can be released through your skin and spread the infection to your sex partner(s).

How can I reduce my risk of getting herpes?

The only way to avoid STDs is to not have vaginal, anal, or oral sex.

If you are sexually active, you can do the following things to lower your chances of getting herpes:

Being in a long-term mutually monogamous relationship with a partner who has been tested and has negative STD test results;

Using latex condoms the right way every time you have sex.

Herpes symptoms can occur in both male and female genital areas that are covered by a latex condom. However, outbreaks can also occur in areas that are not covered by a condom so condoms may not fully protect you from getting herpes.

I’m pregnant. How could genital herpes affect my baby?

If you are pregnant and have genital herpes, it is even more important for you to go to prenatal care visits. You need to tell your doctor if you have ever had symptoms of, been exposed to, or been diagnosed with genital herpes. Sometimes genital herpes infection can lead to miscarriage. It can also make it more likely for you to deliver your baby too early. Herpes infection can be passed from you to your unborn child and cause a potentially deadly infection (neonatal herpes). It is important that you avoid getting herpes during pregnancy.

If you are pregnant and have genital herpes, you may be offered herpes medicine towards the end of your pregnancy to reduce the risk of having any symptoms and passing the disease to your baby. At the time of delivery your doctor should carefully examine you for symptoms. If you have herpes symptoms at delivery, a â€˜C-sectionâ€™ is usually performed.

How do I know if I have genital herpes?

Most people who have herpes have no, or very mild symptoms. You may not notice mild symptoms or you may mistake them for another skin condition, such as a pimple or ingrown hair. Because of this, most people who have herpes do not know it.

Genital herpes sores usually appear as one or more blisters on or around the genitals, rectum or mouth. The blisters break and leave painful sores that may take weeks to heal. These symptoms are sometimes called â€œhaving an outbreak.â€ The first time someone has an outbreak they may also have flu-like symptoms such as fever, body aches, or swollen glands.

Repeat outbreaks of genital herpes are common, especially during the first year after infection. Repeat outbreaks are usually shorter and less severe than the first outbreak. Although the infection can stay in the body for the rest of your life, the number of outbreaks tends to decrease over a period of years.

You should be examined by your doctor if you notice any of these symptoms or if your partner has an STD or symptoms of an STD, such as an unusual sore, a smelly discharge, burning when urinating, or, for women specifically, bleeding between periods.

How will my doctor know if I have herpes?

Often times, your healthcare provider can diagnose genital herpes by simply looking at your symptoms. Providers can also take a sample from the sore(s) and test it. Have an honest and open talk with your health care provider and ask whether you should be tested for herpes or other STDs.

Can herpes be cured?

There is no cure for herpes. However, there are medicines that can prevent or shorten outbreaks. One of these herpes medicines can be taken daily, and makes it less likely that you will pass the infection on to your sex partner(s).

What happens if I don’t get treated?

Genital herpes can cause painful genital sores and can be severe in people with suppressed immune systems. If you touch your sores or the fluids from the sores, you may transfer herpes to another part of your body, such as your eyes. Do not touch the sores or fluids to avoid spreading herpes to another part of your body. If you touch the sores or fluids, immediately wash your hands thoroughly to help avoid spreading your infection.

Some people who get genital herpes have concerns about how it will impact their overall health, sex life, and relationships. It is best for you to talk to a health care provider about those concerns, but it also is important to recognize that while herpes is not curable, it can be managed. Since a genital herpes diagnosis may affect how you will feel about current or future sexual relationships, it is important to understand how to talk to sexual partners about STDs. You can find one resource here: GYT Campaign.

Can I still have sex if I have herpes?

If you have herpes, you should tell your sex partner(s) and let him or her know that you do and the risk involved. Using condoms may help lower this risk but it will not get rid of the risk completely. Having sores or other symptoms of herpes can increase your risk of spreading the disease. Even if you do not have any symptoms, you can still infect your sex partners.

What is the link between genital herpes and HIV?

Genital herpes can cause sores or breaks in the skin or lining of the mouth, vagina, and rectum. The genital sores caused by herpes can bleed easily. When the sores come into contact with the mouth, vagina, or rectum during sex, they increase the risk of giving or getting HIV if you or your partner has HIV.

In recent years, there has been a reduction in rates of teen pregnancy, births, and abortions. Similarly there has been a drop off in the share of adolescents engaging in sexual activity. Despite this shift, recent data indicate that the rates of unintended pregnancy and sexually transmitted infections (STIs) among teens and young adults remain higher in the U.S. than in other developed nations and are considerably higher among certain racial and ethnic minorities and in different geographic regions in the nation. This fact sheet provides key data on sexual activity, contraceptive use, pregnancy, prevalence of STIs, and access to reproductive health services among teenagers and young adults in the U.S.

Sexual Activity

Nearly half (47%) of all high school students report ever having had sexual intercourse in 2013, a decline from 54% in 1991. A similar share of male and female students report ever having had sex (48% vs. 46%).1

There are racial and ethnic differences in sexual activity rates. Black high school students are more likely to have had intercourse (60%) compared to White (44%) and Hispanic students (49%). A higher share of Black high school students (14%) and Hispanic students (6%) initiated sex before age 13 compared to White students (3%).2

More than one in ten (13%) female teens and one in six (17%) male teens had more than four sexual partners in their lives. The percentage of high school students who report having had four or more sexual partners declined from 18% in 1995 to 15% in 2013.3

One-third (34%) of high school students are currently sexually active, defined as having had sexual intercourse with at least one person in the previous three months. Almost one-quarter (22%) of these students reported using alcohol or drugs during their most recent sexual encounter. More males reported using alcohol or drugs (26%) compared to females (19%), and White males (28%) had higher rates than Black males (19%).4

One in ten high school students who dated or went out with someone within the previous 12 months reported having experienced dating violence. More than 10% of students reported experiencing physical violence, and 10% of students reported experiencing sexual dating violence. Seven percent of students have been physically forced to have sexual intercourse, with more females (11%) than males (4%) reporting this experience.5 One in four women ages 15 to 24 report that they have talked with a health care provider about dating violence.6

Young women experience the highest rates of rape and sexual assault among all age groups. More than 1 in 5 (22%) college women have been victims of physical abuse, sexual abuse, or threats of physical violence.7 Among women who have ever been raped, 30% were raped when they were between the ages of 11 and 17 and 37% were raped between the ages of 18 and 24.8

“Sexting” is the exchange of explicit sexual messages or images by mobile phone. More than one in ten (13%) 14 to 24 year olds report having shared a naked photo or video of themselves via digital communication such as the internet or text messaging.9

Twice as many young adults identify as lesbian, gay, bisexual, or transgender (LGBT) compared to older adults. A 2013 survey found 6.4% of adults ages 18 to 29 identified as LGBT compared to 3.2% of 30 to 49 year olds.10

Contraception

Three quarters (74%) of teen girls reported learning about birth control in school.11 Half (50%) of teen girls ages 15 to 18 discussed contraception with a health care provider, compared to 77% of young adult women (ages 19 to 24).12 Among adolescents, 53% of females and 45% of males talked about contraception or STIs with their partner before their first time having sex.13

22% of teen females and 14% of teen males reported they did not use contraception at first intercourse.14 Research has shown that those who reported condom use at their sexual debut were more likely to engage in protective behaviors than those who did not report condom use at first intercourse.15

Two thirds (66%) of sexually active teen males and half (53%) of teen females said they had used a condom at last sexual intercourse (Table 1).16

Table 1: Types of contraceptives used by teens or by teen’s partner during last sexual intercourse, among teens ages 15-19

Type of contraceptive

All teens, ages 15-19

White, Non-Hispanic

Black, Non-Hispanic

Hispanic

Males

Females

Condom

59.1%

57.1%

64.7%

58.3%

65.8%

53.1%

Birth Control Pills

19%

25.9%

8.2%

9.0%

15.1%

22.4%

IUD/Implant

1.6%

1.9%

1.1%

1.3%

1.3%

1.8%

Shot/Patch/Ring

4.7%

4.8%

5.7%

4.3%

3.7%

5.6%

NOTE: Totals do not round to 100% because some teens may use more than one method and other teens do not use any methods.SOURCE: CDC. Youth Risk Behavior Surveillance System: US, 2013. MMWR, 63(-4). 2014.

19% of currently sexually active high school students report that they or their partner used birth control pills to prevent pregnancy at last sexual intercourse. 17 White students (26%) were more likely to use birth control pills compared to Black (8%) and Hispanic (9%).18 Approximately 9% of teens used both condoms and one other method of contraceptive during last sexual intercourse.

Emergency contraceptive (EC) pills can prevent pregnancy when taken within a few days of unprotected intercourse. One type of EC pill, Plan B, is available without a prescription in-front-of-the-counter without age restrictions. Other ECs, such as ella, are available with a prescription. Most teen girls age 15 to 18 (78%) report that they have heard of EC pills.19 From 2006 through 2010, 14% of female teens who had ever had sex had ever used EC pills.20

The American Congress of Obstetricians and Gynecologists (ACOG) formally recommends long-acting reversible contraceptives (LARCs), such as intra-uterine devices (IUDs), for adolescents.21 LARCs are considered among the most effective forms of reversible contraception. However, utilization rates have been increasing. Approximately 7.4% of women aged 15 to 19 used a LARC in 2013, including an IUD, contraceptive patch, contraceptive implants, vaginal ring or injection.22

IUDs have historically had high up-front costs with insertion and supplies typically costing between $500 and $1,000. The Affordable Care Act (ACA) requires most new private plans to cover many preventive services important for sexual health without cost sharing, including FDA approved prescribed contraceptive services and supplies for women.23 When financial barriers are removed, studies have shown a majority of women will choose LARCs which have the highest effectiveness rate.24

Pregnancy

The pregnancy rate among female teens ages 15 to 19 in 2010 was 57.4 per 1,000, a drop of more than 50% since the peak in 1990.25 Despite the decline in this rate over the past decade, the U.S. continues to have among the highest teen pregnancy, birth, and abortion rates in the developed world.26

The teen birth rate has decreased significantly over the past decades, falling to 27 births per 1,000 females ages 15 to 19 in 2013 from 62 births per 1,000 females in 1991 (Figure 1).27

Although birth rates have fallen for teens of all races and ethnicities, the rates for African American, Hispanic and Native American teens are over twice the rates of White and Asian American youth (Figure 2).

There are also geographic differences in teen birth rates across the nation. In 2012, teen birth rates were highest in South Central states and lowest in the Northeast (Figure 3). The range varied considerably by state with New Mexico having the highest rate (47.5 births per thousand females 15 to 19) compared to a low in New Hampshire (13.8 births per thousand females 15 to 19).28 Teen birth rates have been declining in rural areas, but not as quickly as in suburban and urban areas.29

The vast majority (82%) of teen pregnancies are unplanned compared to less than half of women above age 25.30 These teen pregnancies comprise more than one sixth of total unintended pregnancies annually in the U.S. and 36% of these unintended pregnancies end in abortion.31 Approximately 18% of women having abortions in the U.S. are teens and 33% are between the ages of 20 and 24.32 Women ages 15 to 19 comprised 17% of women of reproductive age (ages 15 to 44) in 2008.33

Sexually Transmitted Infections (STIs) and HIV/AIDS

Compared to older adults, sexually active teens and young adults are at higher risk for acquiring STIs, due to a combination of behavioral, biological and cultural factors (Figure 4). Though they make up 25% of the sexually active population, they account for nearly half of new STI cases.34

HPV is the most common STI among teens, with some estimates reaching an infection rate of 35% of 14 to 19 year olds.35 Currently, there are two vaccines (Gardasil and Cervarix) that protect against strains of HPV associated with cervical cancer and genital warts. The CDC recommends that all girls and women up to age 26 receive the 3 dose course of HPV vaccinations, as well as all boys up to age 21.36 These vaccines are now covered by private insurance without cost sharing, along with counseling on and screening for sexually transmitted infections, by the ACA’s policy for coverage of preventive services.37

Teens ages 15 to 19 and young adults ages 20 to 24 accounted for the most reported cases of Chlamydia and Gonorrhea in 2012. Females are at greater risk than men of acquiring sexually transmitted infections, and the consequences include pelvic inflammatory disease, pregnancy complications, and infertility.38

Despite the high rates of infection, many young women do not receive provider counseling on STIs. One-third of teen girls and almost half (45%) of young adult women ages 19 to 25 report that they have discussed STIs with their providers in the past three years.39

Research has found that STI screening rates vary among youth. One study estimates that 37% of young men and 70% of young women ages 15 to 24 had an STI test in the past year.40 However, in another recent survey, more than half (56%) of young women who reported having an STI test incorrectly assumed it was a routine part of the exam, which is often not the case.41

Over 34,000 young people, ages 13 to 24, were estimated to be living with HIV in the U.S in 2009.42 This age group accounts for 26% of new HIV infections. Most young people with HIV/AIDS were infected through sexual contact.43

In 2013, 85% of high school students reported that they had been taught about AIDS or HIV infection in school.44 However, there are still gaps in knowledge about HIV/AIDS. One-third of teens ages 12-17 do not know that HIV is an STI.45

Access to Services

Health insurance coverage and the ability to pay for services affect teens’ access to reproductive health care. Prior to many of the ACA insurance coverage benefits taking effect, approximately 25% of young adults 19 to 25 years old were uninsured and 15% were covered by Medicaid in 2012. Six in ten (61%) young adults lived in a low-income household (below 200% of the federal poverty level).46 After the initial insurance enrollment period in 2014, the uninsured rate among young adults ages 18 to 25 has declined to 18.7%.47

Confidentiality is a priority for teens and young adults. In a national survey, 70% of women 19 to 24 rated confidentiality about use of health care such as family planning or mental health services as “important”; however, the majority of girls and women were not aware that insurers may send an explanation of benefits (EOB) that documents use of medical services that have been used to the principal policy holder, who may be a parent (Figure 5).48

The Federal Title X program provides confidential contraceptive services and STI screening and treatment for low-income teens and young adults by funding approximately 4,400 clinics, public health departments and hospitals, available in 72% of US counties.49

Currently, Medicaid funds 75% of publicly funded family planning services in the U.S.50 Family planning is a mandatory service under Medicaid and states are not permitted to charge cost-sharing for family planning services.

Today, 21 states and DC have policies that explicitly allow minors to consent to contraceptive services, 25 allow consent in certain circumstances, and 4 have no explicit policy.51

38 states require some level of parental involvement in a minor’s decision to have an abortion, up from 18 states in 1991. 21 states require that teens obtain parental consent for the procedure, 12 require parental notification, and 5 require both.52

If you are sexually active, getting tested for STDs is one of the most important things you can do to protect your health. Make sure to have an open and honest conversation with your doctor about your sexual history and STD testing. A recent study found that one-third of teens didn’t talk about issues of sex and sexuality during their annual health visits.

If you are not comfortable talking with your regular health care provider about STDs, there are many clinics that provide confidential and free or low-cost testing. It is also important that you find and visit a doctor or other medical provider who stays current on STD and HIV testing recommendations.

Screening Recommendations

All adults and adolescents from ages 13 to 64 should be tested at least once for HIV.

Annual chlamydia and gonorrhea screening of all sexually active women younger than 25 years, as well as older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection.

Syphilis, HIV, chlamydia, and hepatitis B screening for all pregnant women, and gonorrhea screening for at-risk pregnant women starting early in pregnancy, with repeat testing as needed, to protect the health of mothers and their infants.

Screening at least once a year for syphilis, chlamydia, and gonorrhea for all sexually active gay, bisexual, and other men who have sex with men (MSM). MSM who have multiple or anonymous partners should be screened more frequently for STDs (i.e., at 3-to-6 month intervals).

Anyone who has unsafe sex or shares injection drug equipment should get tested for HIV at least once a year. Sexually active gay and bisexual men may benefit from more frequent testing (e.g., every 3 to 6 months).